Kaiser Permanente researchers find that use of telehealth for antenatal care has nearly doubled during the pandemic
Pregnant patients who received some of their antenatal care during the COVID-19 pandemic in a combination of virtual and in-office visits known as multimodal antenatal care had health outcomes similar to those seen primarily in-person before the pandemic, according to a large new study of more than 150,000 births from the Kaiser Permanente Division of Research.
The study also found no significant differences in the adoption of telehealth antenatal care and how it affected people of different racial and ethnic groups or socioeconomic backgrounds and those who use a language other than English or live in a rural area. These findings address concerns that people who may have less access to video assist technology may have worse health outcomes.
The findings suggest that remote care could have an ongoing role in replacing some in-person prenatal visits, increasing convenience for those who want to be seen at home, without harming the disadvantaged, said lead author Assiamira Ferrara, MD, PhD, senior research scientist in the Division of Research.
Integrating the use of telehealth into antenatal health care provides an alternative to solely in-office care for people who live in underserved areas or face barriers to access, Ferrara said. Additionally, the latest guidelines for antenatal care suggest that you do not need to be seen in person for every antenatal visit and that some care can be effectively delivered remotely.
The COVID-19 pandemic period, with its reliance on virtual care, has provided an opportunity for a natural experiment in moving some prenatal care to telephone and video. Recommended antenatal care in Kaiser Permanente Northern California includes 8 to 10 visits from 6 weeks gestation to delivery.
The analysis compared pregnancy care, delivery, and outcomes for 3 different time periods: pre-pandemic delivery (July 2018 to February 2020), early pandemic (March 2020 to December 2020), and mid-pandemic (December 2020 to October 2021). It included 151,464 people who had delivered a live or stillbirth.
The rate of telehealth visits for each patient has increased from 11% to 21% from the pre-pandemic period to the pandemic period. But the average number of antenatal visits per patient has not changed significantly: it was 9.4 pre-pandemic and 9.15 in the pandemic period.
The specifics of prenatal care haven’t changed during the pandemic either: blood pressure readings, gestational diabetes screenings, and depression screenings have remained constant.
Birth outcomes also have not changed significantly with the rise of telehealth during the pandemic. Neonatal intensive care unit (NICU) admissions were 9.2% before the pandemic and 8.6% during. The investigators noted a small upward trend in neonatal NICU admissions during the second half of the pandemic period, which they said needed further investigation.
Rates of preeclampsia (a dangerous hypertensive condition in pregnancy), severe maternal morbidity, cesarean delivery, and preterm delivery did not change significantly between the time periods studied.
Support for multimodal model
The findings support the safety of a shift to more multimodal antenatal care, a shift that had been contemplated even before the pandemic required more remote visits, said co-author Mara Greenberg, MD, a maternal-fetal medicine specialist who co-directs the Kaiser Permanente Regional Perinatal Service Center. As telehealth becomes a more widespread intervention in all areas of medicine, including antenatal care, there is great interest nationwide to better understand patient outcomes and preferences associated with a more diverse way in which patients can receive that care, Greenberg said. This study provides exciting data supporting the continued use of a multimodal care model and further study on how best to intertwine remote visits and in-person visits during pregnancy.
The study used advanced analytical methods, including a sophisticated version of broken time series analysis. Co-author and Division of Research investigator Charles Quesenberry, PhD, led the rigorous study design used to evaluate the effect of natural experiments that allowed comparisons of pregnancy care and outcomes over the course of one pregnancy and at 3 different time periods before and during the pandemic. A strength of the study was its ability to assess the uptake and effectiveness of multimodal antenatal health care based on different sociodemographic factors, Quesenberry said.
The analysis looked at results for subgroups including people of different races and ethnicities, those who live in economically deprived neighborhoods or rural areas, and those who speak languages other than English. We did not observe differences in telehealth uptake by sociodemographic characteristics, Ferrara said.
The study was funded by The Permanente Medical Group.
Other co-authors were Yeyi Zhu, PhD, Lyndsay Avalos, PhD, Amanda Ngo, MS, Jun Shan, PhD, and Monique Hedderson, PhD, all from the Division of Research.
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About the Kaiser Permanente Research Division
Kaiser Permanente’s research division conducts, publishes, and disseminates health services and epidemiological research to improve the health and medical care of Kaiser Permanente members and society at large. Seek to understand the determinants of disease and well-being and improve the quality and cost-effectiveness of health care. Currently, more than 600 DOR employees are working on more than 450 health services and epidemiology research projects. For more information, visitdivisionofresearch.kaiserpermanente.orgor follow us @KPDOR.
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